Abstract
Little is known about the dimensions of osteoporosis prevention programs essential to changing health behaviors. The purpose of this review was to determine the impact of select characteristics of structured osteoporosis prevention programs on calcium intake in women. This systematic review included 12 experimental and quasi-experimental studies conducted internationally with adult women participants. Studies were more likely to demonstrate differences when they were conducted outside the U.W.; participants had lower baseline calcium intake; and interventions were multi-dimensional and included factual information, skill training, and social contact delivered dynamically over time. The results document extensive variability across participants, programs, and measures. There is a need to document the source (total and sub-total) of calcium intake, to provide the necessary data to calculate effect sizes to enable comparison across studies, and to identify those moderating factors (such as menopausal status) that affect the ability to determine differences between sub-groups. Results indicate health behavior change is more likely to occur when patient-centered interventions designed to increase knowledge and health beliefs, skills and abilities, and social facilitation are delivered over time. There is an urgent need for the development and testing of new health behavior change theories, prevention programs, and delivery media to support and complement health care providers in the prevention and management of this common, debilitating condition.
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References
Cole ZA, Dennison EM, Cooper C (2008) Osteoporosis epidemiology update. Curr Rheumatol Rep 10:92–6
National Osteoporosis Foundation (NOF) (2011) Fast Facts. 2012. http://www.nof.org
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22:465–75
Cole RE (2011) Clinical strategies to address patients’ concerns in osteoporosis management with bisphosphonates. Postgrad Med 123:131–44
Holroyd C, Cooper C, Dennison E (2008) Epidemiology of osteoporosis. Best Pract Res Clin Endocrinol Metab 22:671–85
Sanchez-Riera L, Wilson N, Kamalaraj N, Nolla JM, Kok C, Li Y, Macara M, Norman R, Chen JS, Smith EU, Sambrook PN, Hernandez CS, Woolf A, March L (2010) Osteoporosis and fragility fractures. Best Pract Res Clin Rheumatol 24:793–810
Iqbal MM (2000) Osteoporosis: epidemiology, diagnosis, and treatment. South Med J 93:2–18
Gambrell RD Jr (2004) The women’s health initiative reports in perspective: facts or fallacies? Climacteric 7:225–8
Jackson RD, Donepudi S, Mysiw WJ (2008) Epidemiology of fracture risk in the Women’s Health Initiative. Curr Osteoporos Rep 6:155–61
Utian WH (2007) NIH and WHI: time for a mea culpa and steps beyond. Menopause 14:1056–9
Ryan P (2009) Integrated theory of health behavior change: background and intervention development. Clin Nurse Spec 23:161, 70; quiz 171–2
Schnatz PF, Marakovits KA, Dubois M, O’Sullivan DM (2011) Osteoporosis screening and treatment guidelines: are they being followed? Menopause 18:1072–8
Recker R (2011) NOF President, Dr. Robert Recker, delivered remarks Friday, September 9 at the joint meeting of the FDA Reproductive Health Drugs and Drug Safety and Risk Management Advisory Committee. 2012
International Osteoporosis Foundation (2011) Facts and statistics about osteoporosis and its impact. 2012. www.iofbonehealth.org
Andrist LC, MacPherson KI (2001) Conceptual models for women’s health research: reclaiming menopause as an exemplar of nursing’s contributions to feminist scholarship. Annu Rev Nurs Res 19:29–60
Finkelstein JS, Brockwell SE, Mehta V, Greendale GA, Sowers MR, Ettinger B, Lo JC, Johnston JM, Cauley JA, Danielson ME, Neer RM (2008) Bone mineral density changes during the menopause transition in a multiethnic cohort of women. J Clin Endocrinol Metab 93:861–8
Harlow SD, Crawford S, Dennerstein L, Burger HG, Mitchell ES, Sowers MF, ReSTAGE Collaboration (2007) Recommendations from a multi-study evaluation of proposed criteria for staging reproductive aging. Climacteric 10:112–9
Netz Y, Zach S, Dennerstein L, Guthrie JR (2005) The menopausal transition: does it induce women’s worries about aging? Climacteric 8:333–41
Dennerstein L, Lehert P, Guthrie JR, Burger HG (2007) Modeling women’s health during the menopausal transition: a longitudinal analysis. Menopause 14:53–62
Straus SE, Tetroe J, Graham I (2009) Defining knowledge translation. CMAJ Can Med Assoc J 181:165–8
Cooper H, Hedges LV (1994) The handbook of research synthesis. Russell Sage Foundation, New York
Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB (2000) Evidence-based medicine: how to practice and teach EBM. Churchill Livingstone, Edinburgh
Fineout-Overholt E (2008) Synthesizing the evidence: how far can your confidence meter take you? AACN Adv Crit Care 19:335–9
Lv N, Brown JL (2011) Impact of a nutrition education program to increase intake of calcium-rich foods by Chinese-American women. J Am Diet Assoc 111:143–9
Ribeiro V, Blakeley JA (2001) Evaluation of an osteoporosis workshop for women. Public Health Nurs 18:186–93
Manios Y, Moschonis G, Grammatikaki E, Katsaroli I, Kanelou P, Tanagra S (2006) Nutrition education in postmenopausal women: changes in dietary and cardiovascular indices. Maturitas 55:338–47
Winzenberg T, Oldenburg B, Frendin S, De Wit L, Riley M, Jones G (2006) The effect on behavior and bone mineral density of individualized bone mineral density feedback and educational interventions in premenopausal women: a randomized controlled trial [NCT00273260]. BMC Publ Health 6:12
Hien VT, Khan NC, le Mai B, Lam NT, Phuong TM, Nhung BT, Nhien NV, Nakamori M, Yamamoto S (2009) Effect of community-based nutrition education intervention on calcium intake and bone mass in postmenopausal Vietnamese women. Public Health Nutr 12:674–9
Kulp JL, Rane S, Bachmann G (2004) Impact of preventive osteoporosis education on patient behavior: immediate and 3-month follow-up. Menopause 11:116–9
Peterson BA, Klesges RC, Kaufman EM, Cooper TV, Vukadinovich CM (2000) The effects of an educational intervention on calcium intake and bone mineral content in young women with low calcium intake. Am J Health Promot 14:149–56
Sedlak CA, Doheny MO, Estok PJ, Zeller RA, Winchell J (2007) DXA, health beliefs, and osteoporosis prevention behaviors. J Aging Health 19:742–56
Blalock SJ, Currey SS, DeVellis RF, DeVellis BM, Giorgino KB, Anderson JJ, Dooley MA, Gold DT (2000) Effects of educational materials concerning osteoporosis on women’s knowledge, beliefs, and behavior. Am J Health Promot 14:161–9
Blalock SJ, DeVellis BM, Patterson CC, Campbell MK, Orenstein DR, Dooley MA (2002) Effects of an osteoporosis prevention program incorporating tailored educational materials. Am J Health Promot 16:146–56
Brecher LS, Pomerantz SC, Snyder BA, Janora DM, Klotzbach-Shimomura KM, Cavalieri TA (2002) Osteoporosis prevention project: a model multidisciplinary educational intervention. J Am Osteopath Assoc 102:327–35
Sedlak CA, Doheny MO, Estok PJ, Zeller RA (2005) Tailored interventions to enhance osteoporosis prevention in women. Orthop Nurs 24:270, 6; quiz 277–8
Dennerstein L, Lehert P, Burger HG, Guthrie JR (2007) New findings from non-linear longitudinal modelling of menopausal hormone changes. Hum Reprod Update 13:551–7
National Osteoporosis Foundation (NOF) (2008) Quick calcium estimate. In Boning up on osteoporosis: a guide to prevention and treatment. National Osteoporosis Foundation, Washington DC, USA
Conn VS, Valentine JC, Cooper HM, Rantz MJ (2003) Grey literature in meta-analyses. Nurs Res 52:256–61
Conn VS, Armer JM (1996) Meta-analysis and public policy: opportunity for nursing impact. Nurs Outlook 44:267–71
Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE, Bassford T, Beresford SA, Black HR, Blanchette P, Bonds DE, Brunner RL, Brzyski RG, Caan B, Cauley JA, Chlebowski RT, Cummings SR, Granek I, Hays J, Heiss G, Hendrix SL, Howard BV, Hsia J, Hubbell FA, Johnson KC, Judd H, Kotchen JM, Kuller LH, Langer RD, Lasser NL, Limacher MC, Ludlam S, Manson JE, Margolis KL, McGowan J, Ockene JK, O’Sullivan MJ, Phillips L, Prentice RL, Sarto GE, Stefanick ML, Van Horn L, Wactawski-Wende J, Whitlock E, Anderson GL, Assaf AR, Barad D, Investigators W’s H I (2006) Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med 354:669–83
Kuller LH, Matthews KA, Meilahn EN (2000) Estrogens and women’s health: interrelation of coronary heart disease, breast cancer and osteoporosis. J Steroid Biochem Mol Biol 74:297–309
Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A (2007) Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 370:657–66
Stone AA, Turkkan JS, Bachrach CA, Jobe JB, Kurtzman HS, Cain VS (eds) (2000) The science of self-report: implications for research and practice. Lea Lawrence Erlbaum Associates, Mahwah
Kawachi I, Kennedy BP (2002) The health of the nations: why inequality is harmful to your health. New York Press, New York
Free C, Phillips G, Felix L, Galli L, Patel V, Edwards P (2010) The effectiveness of M-health technologies for improving health and health services: a systematic review protocol. BMC Res Notes 3:250
Webb TL, Joseph J, Yardley L, Michie S (2010) Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res 12:e4
Gibbons MC, Wilson RF, Samal L, Lehman CU, Dickersin K, Lehmann HP, Aboumatar H, Finkelstein J, Shelton E, Sharma R, Bass EB (2009) Impact of consumer health informatics applications. Evidence Report/Technology Assessment: 1–546. Agency for Health Care Quality and Research, Rockville, MD, USA
Ybarra ML, Suman M (2006) Help seeking behavior and the Internet: a national survey. Int J Med Inf 75:29–41
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Ryan, P., Schlidt, A. & Ryan, C. The impact of osteoporosis prevention programs on calcium intake: a systematic review. Osteoporos Int 24, 1791–1801 (2013). https://doi.org/10.1007/s00198-012-2259-4
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DOI: https://doi.org/10.1007/s00198-012-2259-4